Thursday, April 23, 2009

After reading thru Chap. 13

1.) Successful cardiac surgery relies not only on modern technological advances but the practiced skill of the surgeon. Cardiac surgeons often get this experience by working on animals. Dr. Nolen describes “the dog lab” at one hospital. What are your thoughts on using dogs (or other animals) for this type of training? What does Dr. Nolen think?

2.) Dr. Nolen describes the frustration of patients with tuberculosis whose disease takes a long time to respond to medication. TB patients can be quite contagious yet Dr. Nolen describes patients checking themselves out of the hospital. Do you think there should be regulations regarding the rights of people with infectious diseases to choose not to be in the hospital and/or not to choose to undergo a course of medication?

24 comments:

1. Dr. Nolen speaks of the dog lab as if it were a very undesirable place to be positioned. He seems to think it is below him to practice on lowly dogs. I think the question you asked could be viewed in the light of animals rights. However relevant that argument may be for us Bekeleyites, it strikes me that Dr. Nolan never once even thought about how the animals feel or the pain he might be inflicting on them. Once again, Dr. Nolan shows that he has a superiority complex. He doesn't even acknowledge the legitimate concerns of animal rights activists. Personally, I think that this kind of practice on animals is necessary to the training of doctors. Although I don't condone doing procedures on animals in such a manner that the animal feels excruciating pain, I don't see any other way to obtain this kind of training for doctors.

2. TB is a very scary disease, especially the new drug-resistant strains that are emerging in Russian prisons. I think that it is absolutely necessary for hospitals to regulate the release of patients with TB because if patients check out before they are cured they risk creating new drug-resistant strains of TB that could affect millions of other people. I think that perhaps patients would be less likely to leave early if they had more to do while in the hospital. Or, maybe hospital supervised outings could be arranged to take patients to a park to paint or something like that. It is sad that people who suffer from TB must undergo both strenuous treatments and separation. They are the modern day equivalent to lepers. However, you would hope that humanity has progressed to the point where hospitals are aware of and responsive to the emotional needs of TB patients. I believe that, while regulations are necessary for the safety of human kind, TB patients need to be afforded a hospital experience during which they feel well cared for and have a decent quality of life.

1. He really disapproves of the dog lab, like it's something really terrible to have to do dog dissections. Personally, I'm really conflicted. But I think that despite what activists might say, so much of our medicine is based upon the dissection of animals, that you can't say that there might be other alternatives; nothing beats looking at the "real thing." Of course, you might also say that dogs are completely different animals and that there's no point in dissecting them, but we're both mammals, and many of our organs are actually quite similar. I suppose that if you can overcome the fact that you are dissecting a dog, you might actually get a lot out of it; you can become really adept at a procedure which can save a life. I think that in terms of animal testing in general, my opinion holds true. It might allow us to have a superiority complex, but at the same time, how could we have developed medicine without dissecting or testing animals? I think that as long as it's "humane" it should be allowed.

2. I think that this is such a touchy topic, because the people inside the hospitals are also suffering too. I couldn't imagine what it would be like to live with TB in a hospital with a very poor prognosis of being able to go outside the hospital ever again. And if they do go outside, what would it be like to live with the fact that you might kill someone because you are being "selfish," when in fact you really aren't? There really isn't an easy way to answer this question. I think it's the person's (who is sick) duty to take the course of medication; how is it fair that they might go and spread their TB (for example) to other people? But in terms of the long term: it gets trickier. Perhaps setting up some sort of outlet for these people, where they can just go have some fun might relieve some of their difficulties dealing with the long term stay in the hospital. Be it a basketball game, or a craft or just a library, I think it would be much more helpful if these patients had some contact with normalcy. I think even watching movies and interacting with people with similar cases would help tremendously.

Dr. Nolen does not appear to be very opposed to animal testing and/or training on animals. This is understandable, because I imagine that since he has been studying and working in medicine so extensively for so many years, training on dogs may seem more ordinary and not so traumatic. However, Dr. Nolen does express great disapproval at most of the basic research conducted in dog labs, much of which he literally describes as “garbage.” He depicts basic research as wasteful and a means for researchers and doctors to gain prestige and push forward their personal interests—a very small percentage of the work is actually useful for humanity. Personally, I think that training on animals is, unfortunately, a vital part of medical training. Doctors need to gain experience and test procedures on living organisms, but in many cases it is unethical to go through with an extremely high risk procedure in human patients. I cannot think of alternative to advancing medical research through experiments on anything other than animals at this point. I support animal rights, but when it comes to research (not self-promoting “garbage”) necessary for the development of potentially life-saving technologies and techniques, I see animal testing as a viable but unfortunate and undesirable option. I do support, however, strict regulations on the treatment and sacrifice of animals during testing.

I sympathize with the TB patients and can understand being hospitalized for an extended period of time and/or undergoing a rigorous course of medication are undesirable and even dreadful. However, it is immoral and irresponsible to let such a dangerous and life-threatening illness spread to innocent victims. Furthermore, spreading this disease is especially easy since it is highly infectious. Consequently I strongly support regulations to prevent extending the disease to others. However, there should also be regulations protecting the rights of the TB patients to ensure that they are treated humanely and if hospitalized, have special efforts going to make their experience more manageable.

Dr. Nolen isn’t totally against dog labs, but he feels that that kind of training just isn’t for him. I personally think dog labs are horrible. I understand that surgeons need the practice, but I can’t imagine humans surgically practicing on “man’s best friends”. While I was reading, my dog was on my bed next to me. I can’t imagine my baby being used for medical practice. I think it’s a cruel practice, inflicting pain on helpless animals. Why can’t medical students learn procedures on real patients? Of course I wouldn’t want them to be operating alone. They would be paired with an expert surgeon and survey his work for the first several operations. Then eventually, with the aid of the expert, slowly operate on the patients themselves. I don’t think it’s necessary for innocent animals to get hurt in the process of learning. And it’s the 21st century… can’t we invent like a mock person for people to work on? Like a dummy or something? Tuberculosis is a highly contagious disease, and I strongly believe that there should be regulations regarding the release of patients with the disease. I don’t think it’s fair for the rest of the world if there are people walking around contaminating their community. I sympathize for those who catch the disease, I can’t imagine being locked up in a hospital for several years. But I believe that is it for the greater good if the patients are kept in an enclosed environment where they can’t spread the dangerous disease.

1) Using a dog or another mammal for practice seems like good initial practice. I think it would be helpful for teaching first time interns vital surgical skills such as use of scalpels, tying stitches, etc. However once a surgeon has these skills I think the use of dogs as practice diminishes in value. I'm sure it could help, no doubt, but to me it just seems so much more important to practice on what you'll really be operating on. Dr Nolen doesn't seem to like operating on dogs, or anything regarding dogs and surgery, in his book, though he appreciates that his colleague Kevin does.

2)With something like public health at stake, I think maybe individual rights should be sacrificed for the sake of treatment. If a patient is diagnosed with a contagious disease which is seriously dangerous then I think the doctors should hold he or she for a set period of time to try to treat the disease. Of course there'd have to be oversight, so maybe there could be a committee of doctors that determines, case by case, whether or not a contagious patient should be kept in a hospital and for how long, depending on the severity of the disease as well as the amount of people the patient is likely to interact with. This and its ignoring of individual rights is a stretch, yeah, so at the least there should be some kind of identification for people who have a contagious disease but have checked themselves out of treatment, similar to necklaces worn by those with severe allergies that warn EMS of anaphylaxis to certain substances.

Dr. Nolen doesn't like/enjoy working on animals at all. However, I am not sure if I agree with what Alice said about his feelings of superiority. I think he does not tolerate the "dog lab" because he thinks that most of the work that gets done there is not beneficial to the furthering of a surgeon's skills. I think I'm a terrible person to answer the question about any kind of testing/operating on animals, because I'm not very empathetic. I understand completely what people say about dogs suffering, but my thoughts are, if a young surgeon can practice on a dog and better operate on a human being later on, and possibly save that human's life, then that's a good thing.

I am a firm believer in maintaining personal rights, but I also believe that no one should be able to claim that their rights include endangering the lives of others. It is true that patients cooped up in hospitals are probably miserable, and I wish that there were a way to treat patients without keeping them confined, but it is not fair for patients who may not wish to remain in the hospital to check themselves out and possibly infect people on the street. Personal rights should never trump the safety of others, and it is my personal opinion that the government has every right to regulate the activity of highly contagious individuals so that they do not threaten others with their illness.

1. Although I don't usually advocate for using animals for testing purposes, I think it is a good way for doctors to learn and practice techniques without severely harming a patient. I think this type of practice should be limited because using dogs and other animals for tests seems cruel and perhaps unnecessary. However, I think using animals is a better idea than using humans for this type or research, and I cannot think of a better alternative. Dr. Nolen doesn't seem to object to using dogs in labs, but he does show his dislike toward the type of research that happens in a dog lab. He thinks that most of the knowledge obtained is "garbage" and that this type of work wasn't for him.

2. I sympathize with TB patients completely because I can't imagine how unhappy I would be if I were stuck in a hospital for extended periods of time. However, with a disease like TB, I feel like it is important that these people remain in hospitals because they could easily spread the disease around to others. It seems like it would be a bad idea to let these patients roam among the public, spreading TB around. However, it would be best if they could stay in touch with the rest of the world and normal activities, maybe through some arranged outings with other TB patients. They would still be under the care of doctors, but they could be allowed to get out of the enclosed hospital and experience some outside things.

1. Dr. Nolen seems to feel that the dog lab is an undesirable place to be because most of the time the work that goes on in the dog lab is clinical research. He feels that this is not really what being a doctor is about, and that the more important and real work is being out there and practicing in a hospital with people as patients. I agree with Alice that the first thing that strikes us upon reading about surgical practice on dogs is how cruel it seems to treat dogs that way, but I also feel that in order to provide learning surgeons with experience before they operate for real on humans. Hopefully at some point in the future we may have the ability to create life-like models that have obstacles and complications like a real person but until we have perfected those practice techniques it is certainly necessary to get the required practice. Nolen probably feels a similar way about this although he does not share his thoughts on the subject in his book. I don't think anyone would practice on dogs without any unease, but the probably felt it was the only way to gain experience.

2. As frustrating and annoying it must be to those patients who have struggled with TB for a long time without serious change or improvement, and as much as it seems to be an infringement upon personal freedoms of choice, I have to admit that I feel there definitely should be regulations and restrictions regarding the release of patients with diseases that are this contagious. I think that a patient should only be able to leave when his or her doctor has signed off that they are healthy enough not to be a danger to the public if they leave the hospital. I think as far as choosing to try more medications patients could have more choice. I don't believe that after many attempts to try to cure TB that is resistent to all known drugs a patient should have to continue to try more in vain but it would be their choice to stay in the hospital doing nothing or trying again and again. Whatever their choice of action within the hospital, it would be important that they stay there, or be referred somewhere special for TB patients who are too contagious to live in the public world safely.

1. Dr, Nolen doesn't personally use dog labs, yet doesn't seem completely against practicing surgery on dogs. As a vegetarian, I feel like my automatic response should be to stop and save the animals, yet at the same time I am also pro-human. I totally see the medical benefits for doctors to practice on animals, and while of course I wish that the young doctor had a more humane way to learn I also feel that people deserve to have an experienced doctor operating on them. While at first upon reading this chapter I was horrified by what I read, when i thought about it more I decided that I don't really know what the "right" answer is. I wish there was a way to learn without harm coming to human or animal, but in cases like this I don't know of a way around it. I just hope that one presents itself sooner rather than later.

2. I agree with Cole. I think that while it is important to protect the patient's rights, it is also very important to protect the public health. Of course, it is hard for me to make a statement regarding this because I have never had to suffer being stuck in a hospital for years, and yet I still feel that doctors must take responsibility for their patients. They can not let their personal feelings of sympathy for one patient possibly endanger a whole group of people. Yes, patients should be in control of their treatment options, choosing to take a course of medication or not, but the doctor must be in control when deciding whether or not a contagious patient is fit to be let out into public.

1.Dr. Nolen doesn't like working with dogs or other animal. A motivation for this is that he would prefer to be doing "real" work on real humans. I find it hard to say that I support using healthy animals for medical training, but at the same time it seems necessary to do this. It doesn't seem right to hurt animals that could have been healthy otherwise. However, it comes down to priority: animals or people? I think that it is more important to make sure that doctors and surgeons have the experience to do the best job possible when operating on a human. It is sad that animals would have to suffer because of this and hopefully all animals being "practiced" on are treated humanely and do not feel any pain. Overall, though, I think that it is really important to make sure human patients survive and recover from operations and for now it seems the way to achieve this is through doctors gaining experience by practicing on animals. Hopefully there will be an alternative soon that does not harm animals in any way.

2.I think that it is definitely important to protect the rights of individuals. However there are times when the safety of a very large number of people just seems more important. For example, I have heard of quarantines being enforced for contagious and dangerous diseases in the past. I think that that keeping a patient in the hospital if that patient could potentially spread a disease that could affect many people is necessary. (But, maybe there is a reason that patients with TB were not required to stay in the hospital as opposed to other diseases where quarantines were required?) I don't think doctors should be allowed to force patients to complete treatments, but if a patient could hurt others by refusing treatment, it is not fair to everyone else just let them leave. I can't imagine being stuck in a hospital for years and it sounds terrible. A few people suggested adding facilities for TB patients to go outside or do activities inside to make it more bearable which I think is a great idea.

1.) Successful cardiac surgery relies not only on modern technological advances but the practiced skill of the surgeon. Cardiac surgeons often get this experience by working on animals. Dr. Nolen describes “the dog lab” at one hospital. What are your thoughts on using dogs (or other animals) for this type of training? What does Dr. Nolen think?I think that this is a sad, but necessary evil. While dogs certainly have the ‘cute factor’ which makes us not want to harm them, I don’t believe that they are inherently more valuable than other animals which we consume with abandon. If we’re going to be immoral (and I am no vegetarian), there’s no reason we should muddle our immorality with hypocrisy. If we’re going to eat pigs because they’re tasty, we certainly may dissect dogs if it will allow us to improve the quality of human life. Dr Nolen doesn’t really touch upon the moral nature of this work, but merely remarks upon its boring tedium. He claims that many of the studies conduct on dogs are irrelevant to humans, and are done solely for the purpose of publishing a paper. If this is the case, there should be stricter criteria for dog experiments.

2.) Dr. Nolen describes the frustration of patients with tuberculosis whose disease takes a long time to respond to medication. TB patients can be quite contagious yet Dr. Nolen describes patients checking themselves out of the hospital. Do you think there should be regulations regarding the rights of people with infectious diseases to choose not to be in the hospital and/or not to choose to undergo a course of medication?If they are truly a public health concern, then yes, there should be some type of regulation. If they have an incurable, contagious illness and are destined to live their remaining days in the hospital, there should be some sort of parole-esq type program for eligible patients. In this program, the patients would have to take some sort of medicine regiment to limit their contagiousness, and their activities would have to be monitored to make sure that they were only staying with family and friends who are aware of the risks. If a patient is not incurable and is not terminal, then they should be forced to stay in the hospital until their treatment regimen is completed.

1.) Personally I think using dogs for this type of training is perfectly fine. Of course I feel bad for the animals in question, but for the general good I feel that humanity benefits greatly from this kind of training. Dogs' organ systems are very similar to humans' so practice on dogs is very helpful to beginner surgeons. Despite this, I feel like the scientific technological world is so advanced that dummy patients could be made to simulate a real situation. If a cardiac surgeon could perform surgery on a fake heart/human that was very similar to a real human than that would be much more preferable to a dog. In Dr. Nolen's case, there are no fake humans that act the same as a dog would. He seems to be more opposed to the idea than I am, yet still open to the fact that it is the most practical way for surgeons to practice.

2.) For me, this is one of those big, unanswerable questions in life. So many different opinions have to be weighed in this situation. There are the TB patients feelings that often contradict what is best for society or the patient's health. Being locked up in a hospital not knowing one's own fate seems unbearable. Having to take daily medications that might not even work would be devastating to me. I don't know what I would personally do. I don't know if I would even consider society's needs over my own. From an outsider's point of view I can see why there might need to be some rules implemented about TB patient's freedom of choice. I sympathize with both sides of the argument and honestly cannot be moved to either side right now. I feel like it would be best if somehow there were special institutes for TB sufferers that would specially help out the patients emotional needs while also requiring the patients to try to get better. I just don't feel that regular hospitals would be the right choice for TB patients, but overall I am split over what should be done about their needs vs. society's needs.

1) Though the concept of "dog labs originally shocked me, I think that they sometimes necessary. Though the lives of the animals are being completely desregarded, I think that if dog labs can be used to save lives then it is a good Idea. I think that if the surgeons use it to practice so they don't make mistakes on human patients, than the labs are being put to good use. Also, I think that it is a worthwhile endeavour if the labs are put to research that will save lives. However, if the research is used solely for amusement purposes or for unapplicable knowledge, than they are morally reprehensible. In the case of Dr. Nolen, the dog labs are used just to write papers, much of which "resulted in garbage that wasn't worth the paper it was printed on."

2) With Turberculosis, I think that public safety is incredibly important. I believe that the patient should be kept as safe and healthy as possible, yet the safety of everyone else should be more important. I think the hospital should have full right to decide the release of patients with TB, because new strands of TB could develope that could be drug resistant. I think that this goes for all infectious diseases too. If the public safety can be optimized, the hospital should have full right to determine the release of the patients.

1. Dr. Nolen generally does not enjoy the “dog lab” tests because he feels that he isn’t getting a lot out of them. He is not against the use of animals for tests, he just prefers doing the actual operations. He prefers working with humans to researching dogs. Dr. Nolen admits that the doctors do not operate on the dogs with as much care as they would for a human, but that the process does give doctors practice on certain operations. In my opinion, using dogs for tests is inhumane. I understand that it gives doctors practice, but I do not think it is morally okay to practice something on a living thing. Perhaps one should practice with another type of simulation or model (something inanimate) so that one can practice without cutting open a poor dog.

2. While I do sympathize with the TB patients and their prolonged treatment, I believe that there should definitely be regulations on whether a patient should be discharged or not. As long as the TB patients are getting the proper care, I think they should stay in the hospital until they are healthy, so as to not give the disease to others and to ensure their own good health. Keeping some uncomfortable and unhappy people in the hospital does not exactly compare to having large numbers of people contracting TB and then having to all stay in the hospital. I do, however, think that the patients should be able to decide whether they still wish to try new drugs with the hope that one with work. And if a patient decides not to take more drugs, then they will have to say in the hospital. Having TB is very difficult and sad because the patients do not have much of a choice.

1. I believe that using dogs, or other animals, to practice procedures is a good idea, as it provides a good starting place for someone to practice a procedure for their first time. But once one becomes more accustomed with such a procedure, they should move on from animals, because after all, they are going to be operating on humans. But practicing initially on animals is ok in my opinion because if not on animals, then what will they get practice on? Dr. Nolen thinks that using dogs is a good way to learn a certain procedure, but does not think that doctors should learn how to operate on dogs. Therefore, when a doctor who has been operating only on dogs finally operates on a human, they will be uncomfortable with the whole situation. Either they will be as careless as they were when the patient was a dog, or they will be overly careful because of the knowledge that the patient is not a dog.

2. TB patients definitely have my sympathy, as being confined to a hospital for long periods of time and enduring pretty rigorous treatments must be extremely unpleasant. However, in the end it's kind of what they have to do. The alternative to this, which is for them to be able to leave the hospital and their treatment and wander in the world is something that shouldn't be allowed, because it puts all the people around them outside the hospital at risk. If hospitals give their TB patients the option of neglecting treatment and leaving the hospital, there will be more negative long term effects on the outside world

1) While Dr. Nolen speaks poorly of the dig-dissection labs, I think they are necessary for the advancement of the medical field. Surgeons can learn a great deal from these dissections and although it is sad to take the lives of dogs, I do not think it would be feasible to create an artificial organ to practice on as Corey says. Surgeons must "learn by doing" and dissection is an invaluable tool.

2) I feel very sorry for those stricken with TB who must spend a large portion of their lives in the hospital. I do not think people with infectious diseases should be allowed to mingle with the general public, because such behavior obstructs the rights of other citizens. I agree with Manasi that people undergoing treatment should be able to enjoy themselves and not be entirely confined to the hospital, however I think they must be in a course of medication in order to have these benefits. While it is difficult to largely confine a person who is contagious, I think it may be necessary unless there are effective means of reducing the disease transmission.

It is unfortunate that we will live in a world where we must do "practice" particular surgeries; however, it is important that these trials be done. As you have said "Successful cardiac surgery relies not only on modern technological advances but the practiced skill of the surgeon," and where else would prospective surgeons get this "practiced skill." It would be ideal if we could have a "fake patient" that would involve no-one or no animals getting hurt but the simple truth of the matter is that that technology is certainly not available to him. To conclude, it would be ideal if surgeons did not have to practice on dogs, but the reality is that by doing this, they save the lives of people, and thats why these practices are necessary. Having said this, it is really annoying that Dr. Nolen seems to view himself as above doing this, as the dogs have already given their lives for this cause.

It is not right to tell people what they can and cannot do except in the case where the person's actions would end up harming someone else. This is essentially that case. Although I feel bad for TB patients, if they are contagious they should not be allowed to leave the hospital grounds without special attention given to mitigate the "contagious-ness" of their disease. The imperative in the medical profession is to preserve life. By letting people with contagious TB freely spread it among the populace, you are actively going against that belief. This situation is no different than the the government quarenteening some area where an outbreak of infectious disease occoured.

Personally, I am very opposed to animal testing. I mean, the poor animals may not be able to talk to us but they are still living. Animals, like us, should have a say. I am sure they would not want to be used to train cardiac surgeons. As for Dr. Nolan, he seems to not like the idea of him doing a “dog lab” but he also does not completely disagree with it. I think Dr. Nolan likes the fact that it is helpful to a certain extent, but like I said before it is hurting these dogs.

Since tuberculosis is highly contagious, I do believe that there should be regulations regarding the rights of people with infectious diseases. By checking themselves out of the hospital without being cured, they are putting many other people at risk. Because of that one person, the number of other people who will contract the disease and maybe die in unknown. Also, for the patients own good, they should stay at the hospital. They have to think about their future and other peoples’. It is no fun being “contained” but it is for the greater good… of everyone.

1. "Dog Labs", or any such equivalent, are indispensable in hospitals, especially teaching hospitals. They serve an incredibly important purpose, and their use prevents significant loss of human life, and provides similarly significant teaching and learning opportunities for medical practitioners. Dr. Nolen, however, does not seem to entirely understand the benefits of them, and seems to think himself oddly superior to them, or to their purpose. Animal rights are importance, and human treatment of the subjects is essential, but the use of such facilities is truly unnavoidable.

2. Mandatory hospitalization, once discovered, for highly infectious diseases such as TB might seem like an infringement of privacy and freedom, but isn't, for a few key reasons. The big one is preventing people from dieing of a horrible disease, first off. As well, if you check out before you've been cured... you still have TB, and will suffer the consequences. Mandatory hospitalization in such cases is hardly an extreme thing.

As many people have already stated, Dr. Nolen feels quite negatively toward the Dog Lab. He views the research as hardly beneficial, and the practice unrealistic. Personally, I'm very unsure of this practice. On one hand, I think performing on animals for practice is really impractical. It is simple not the real thing. Though dogs may have similar internal organ structure to humans, the two are very different in all other ways. On the other hand, I strongly believe that surgeons should be well practiced before performing surgery, and perhaps the only way to gain the experience is though animals. :\

I, again, and very conflicted about TB. One one side, I think that patients have to right to seek medical treatment elsewhere, amd not be forced to stay somewhere against their will. On the other side, TB is an incredibly contagious disease, and as people have said before, it would be irresponsible to let infected people to roam about, passing the disease on to innocent people. So I would require that patient should only be able to leave when his or her doctor has signed off that they are healthy enough not to be a danger to the public, as Cole said.

While Dr. Nolen did not seem to like the idea of working in a dog lab and does not really think that they are very useful, he had no moral problems about them. Even doing research on humans did not seem to bother him very much. While I agree to some degree with Dr. Nolen, at least in reference to not holding dogs and humans in different categories, I'm still undecided about whether animal labs are truly worth it. I definitely do not believe that dogs and humans are fundamentally different and should be regarded as such. A human life is not by definition worth more than the life of a dog. In fact, I do not even really believe in the entire concept of values and seeing one thing as better than another. In large part I see this as a result of our language and our society, which dictates the way in which we think. While I don't think that there will be a change in that respect, I firmly hope that there can be.

While TB still is a problem today and treatment still takes a long time, it is more effective than it was during Dr. Nolen's time. So, the many cases of "stir craziness" in patients, as Dr. Nolen mentioned, probably would be somewhat reduced. But when cases do arise, I think that people should be encouraged as much as possible to get the full range of treatments before they are released. I don't think that they should be forced to stay, but if they choose to leave while still carrying TB, they should be fully aware of their situation and the harm they could cause to others. No one should be compelled to take or not take any action, but they should always understand the results of their actions, not so they can be blamed, but just so that thy can have understanding.

1) Although the idea of dog labs is not pleasing, I feel like it is sort of necessary to have dog labs. Dog labs serve the important purpose of allowing doctors to practice surgeries. As much as people would like to find more humane ways for doctors to gain experience, there isn't any other way to practice surgery and gain experience unless people would rather doctors practice on humans instead, which I am sure would be objected immediately. Simply learning through books is not enough to be prepared to do surgeries successfully. Dr Nolen thinks that although dog labs can be useful, he prefers to just stick to human surgeries. He doesn't seem to have any opinion about the moral aspect of dog labs, just the efficiency of using dog labs.

2) Because highly infectious diseases are definitely a harm to others, regulations should be needed to prevent more people from getting TB. I understand that it would really suck to have to stay in the hospital all of the time because of TB and be confined in the hospital, but would also be for the safety of the general public. Perhaps certain hospitals can be expanded to have more activities. For me, I feel like in this situation the safety and health of the public outweighs the relaxation of the released patients.

1) I don't believe that Dr. Nolen likes working in the dog labs, he didn't seem to take much issue with the concept of practicing on dogs. Personally, I see practicing procedures and such on dogs sad, but necessary for surgeons to become more skilled at their practice. It is truly unfortunate that dissections are the only way for doctors to practice, but it must be said that it is better than having doctors practicing on patients, and possible killing or causing serious harm to their patients.

2) Since tuberculosis is such an infectious and dangerous disease, I believe the government must regulate the movement of persons who have contracted it. I don't believe they should be allowed to leave their hospital, and risk others contracting it, just because they are frustrated with how long it is taking. Especially as more drug resistant strains of TB emerge, this should provide more reason to constrict the movements of carriers. There was a recent case where someone with a rare, very drug resistant strain decided to travel, and it caused many worries. I firmly believed some laws must be put in place to stop this.

1. There are too many dogs roaming the streets anyway! We might as well use some of them for useful medical research or surgeon-training purposes. It does make for rather squeamish reading, but better some dissected dogs than a bunch of unnecessarily dead humans.

2. Patients should follow their doctor's advice, even if doctors are not always infallible; but on a subject like tuberculosis they cannot always be trusted to do the smart thing, especially if it is also the boring thing. But the distinction between fair safety regulations and draconian keeping-people-in-hospitals-against-their-will regulations can be quite thin.